University of Toronto
Department of Psychiatry 
Clinician Scholar Program 
250 College Street, Room 832
Toronto, Ontario M5T 1R8

We suggest that you write and edit your application in Microsoft Word (checking word counts), and then cut/paste into the Survey Monkey form when it is ready, as you are not able to save a partially completed application in this form. Please note that you can only apply to one program, either the Clinician Scholar OR Clinician Scientist Program.

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* 1. Resident's Name:

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* 2. Resident's Email Address:

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* 3. Resident's Current Year:

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* 4. Area of Interest (choose one option only):

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* 5. Proposed Supervisor's Name:

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* 6. Proposed Supervisor's Email Address:

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* 7. Proposed Project Title:

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* 8. Lay Person Summary:
Brief project summary that is easy to understand for the lay public without medical background.
Please limit your response to a maximum of 300 words. 

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* 9. Rationale/Background:
Why is the topic important? What is known thus far? Please provide a brief review of the literature. What are the gaps that should be addressed?
Please limit your response to a maximum of 500 words. 


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* 10. Purpose, Aims, and Objectives:
What is the overarching goal of the project? How will it advance knowledge, impact education, improve quality of care, or promote innovation? What aspects are novel? What are the specific hypotheses to be tested (if applicable)?
Please limit your response to a maximum of 500 words. 

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* 11. Methods:
List specific aspects of study design including appropriate and rigorous methods for the type of project that you are doing. Please include a timeline for each stage/step in your project (e.g. data collection, data analysis, etc.)
Please limit your response to a maximum of 500 words. 

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* 12. Environment:
What resources and support are in place to assist you? Who are the other members of the project team, in addition to the proposed supervisor? What is your specific role within the project?
Please limit your response to a maximum of 300 words.

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* 13. Anticipated Deliverables:
e.g. first-author conference presentations, publications, and other knowledge translation activities (be as specific as possible).
Please limit your response to a maximum of 300 words.

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* 14. Anticipated Challenges:
e.g. to the project and/or to the role of the resident within the project, and approach to mitigating these challenges.
Please limit your response to a maximum of 300 words. 

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* 15. Please upload your personal statement.
Only DOC, DOCX, PDF file types; 2 pages at most; maximum size 16MB.

PDF, DOC, DOCX file types only.
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* 16. Please upload your Curriculum Vitae in WebCV format.
Only DOC, DOCX, PDF file types; maximum size 16MB.

PDF, DOC, DOCX file types only.
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* 17. Please upload your proposed supervisor's Curriculum Vitae (preferably in WebCV format).
Only DOC, DOCX, PDF file types; maximum size 16MB.

PDF, DOC, DOCX file types only.
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* 18. Please upload a letter of support from your proposed supervisor.
Only DOC, DOCX, PDF file types; maximum size 16MB.

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* 19. Please upload an independent letter of support from an additional academic reference.
Only DOC, DOCX, PDF file types; maximum size 16MB.

PDF, DOC, DOCX file types only.
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